Risk factors for cardiac complications after spine surgery

Guyot, Juan Pablo; Cizik, Amy M.; Bransford, Richard J.; Bellabarba, Carlo; Lee, Michael J.

doi:10.1055/s-0028-1100910

Cited by 27 publications

(21 citation statements)

References 14 publications

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“…7,16,18,19,24 The CCI was not specifically designed to assess patients undergoing spine surgery, and the usefulness of the CCI score to accurately predict complication occurrence after spine surgery remains uncertain. 2,22,44 The ACS NSQIP Surgical Risk Calculator was developed from a multi-institutional database of surgical procedures across all surgical specialties and draws on a model utilizing 21 preoperative factors to predict postoperative outcomes in individual patients. 3 The ACS NSQIP Surgical Risk Calculator has been shown to perform as well as procedure-specific risk calculators for colon surgery patients.…”

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confidence: 99%

Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

Veeravagu¹,

Li²,

Swinney³

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEThe ability to assess the risk of adverse events based on known patient factors and comorbidities would provide more effective preoperative risk stratification. Present risk assessment in spine surgery is limited. An adverse event prediction tool was developed to predict the risk of complications after spine surgery and tested on a prospective patient cohort.METHODSThe spinal Risk Assessment Tool (RAT), a novel instrument for the assessment of risk for patients undergoing spine surgery that was developed based on an administrative claims database, was prospectively applied to 246 patients undergoing 257 spinal procedures over a 3-month period. Prospectively collected data were used to compare the RAT to the Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. Study end point was occurrence and type of complication after spine surgery.RESULTSThe authors identified 69 patients (73 procedures) who experienced a complication over the prospective study period. Cardiac complications were most common (10.2%). Receiver operating characteristic (ROC) curves were calculated to compare complication outcomes using the different assessment tools. Area under the curve (AUC) analysis showed comparable predictive accuracy between the RAT and the ACS NSQIP calculator (0.670 [95% CI 0.60–0.74] in RAT, 0.669 [95% CI 0.60–0.74] in NSQIP). The CCI was not accurate in predicting complication occurrence (0.55 [95% CI 0.48–0.62]). The RAT produced mean probabilities of 34.6% for patients who had a complication and 24% for patients who did not (p = 0.0003). The generated predicted values were stratified into low, medium, and high rates. For the RAT, the predicted complication rate was 10.1% in the low-risk group (observed rate 12.8%), 21.9% in the medium-risk group (observed 31.8%), and 49.7% in the high-risk group (observed 41.2%). The ACS NSQIP calculator consistently produced complication predictions that underestimated complication occurrence: 3.4% in the low-risk group (observed 12.6%), 5.9% in the medium-risk group (observed 34.5%), and 12.5% in the high-risk group (observed 38.8%). The RAT was more accurate than the ACS NSQIP calculator (p = 0.0018).CONCLUSIONSWhile the RAT and ACS NSQIP calculator were both able to identify patients more likely to experience complications following spine surgery, both have substantial room for improvement. Risk stratification is feasible in spine surgery procedures; currently used measures have low accuracy.

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mentioning

confidence: 99%

Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

Veeravagu¹,

Li²,

Swinney³

et al. 2017

Journal of Neurosurgery: Spine

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“…Previous studies established several clinical and laboratory predictors of perioperative complications in patients undergoing spinal surgery. [4][5][6][7][8][9][10] However, none of these studies comprehensively evaluated preoperative nutritional status in these patients. Malnutrition was associated with an increased risk of PAEs such as perioperative infection, longer hospital stays, and worse outcome after surgery in a variety of patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies reported that prolonged operative time, older age, obesity, and the presence of significant comorbidities are associated with a higher incidence of complications in spinal surgery, such as surgical site infection, delayed wound healing, and cardiovascular complications. [6][7][8][9] These studies showed that preoperative state of health is a key consideration when deciding whether or not it is safe to proceed with elective spine surgery, especially in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

A Novel Prognostic Marker in Patients Undergoing Spinal Surgery: Prognostic Nutritional Index

Acarbaş

2019

J Neurol Surg A Cent Eur Neurosurg

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Objective The relationship of a preoperative Prognostic Nutritional Index (PNI) with perioperative adverse events (PAEs) other than delirium has never been described in patients undergoing spinal surgery. We aimed to evaluate the impact of admission PNI on the outcome of patients undergoing spinal surgery. Methods Medical records of 408 consecutive patients 50 years or older undergoing spinal surgery were reviewed. Patients' information including demographic data, routine preoperative laboratory tests, and PNI were collected to assess the association between these factors and PAEs. The PNI was calculated from this formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count/mm3. Receiver operating characteristic curve analysis was performed to determine the cutoff value of the PNI. Results PAEs occurred in 61 (14.9%) of the patients. Older patients and those with more comorbid conditions such as atrial fibrillation, chronic renal failure, history of malignancy, and diabetes mellitus tended to have a higher rate of PAEs. Patients with PAEs had higher C-reactive protein (4.4 ± 5.4 vs 2.2 ± 3.0 mg/dL; p < 0.001) but had lower hemoglobin levels (12.2 ± 1.57 vs 13.1 ± 1.84 g/dL; p < 0.001) on admission. Patients who had PAEs had a significantly lower preoperative PNI (46.1 ± 4.4 vs 51.9 ± 5.8; p < 0.001) compared with patients without a PAE. Multivariate analysis showed that age (odds ratio [OR]: 1.23; 95% confidence interval [CI] 0.76–1.35; p < 0.04), PNI < 47.7 (OR: 2.51; 95% CI, 1.188–5.477; p = 0.008) and the presence of diabetes (OR: 3.23; 95% CI, 11.326–7.474; p = 0.004) were significant and independent predictors of PAEs. Conclusion This study is the first to demonstrate that a lower preoperative PNI is associated with PAEs in patients undergoing spinal surgery.

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“…[11][12][13] The occurrence of postoperative pulmonary complications significantly increased the in-hospital morbidity and mortality, as well as prolonged hospitalization, increased costs, and compromised quality of life. 12,[14][15][16][17] However, the risk factors of pulmonary complications after minimally invasive surgery for elderly patients with VCFs have not been reported and no risk assessment table established.…”

Section: Introductionmentioning

confidence: 99%

<p>Risk Factors of Pulmonary Complications After Minimally Invasive Surgery for Elderly Patients with Vertebral Compression Fractures</p>

Zhang¹,

Shen²,

Chen³

et al. 2020

TCRM

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Purpose: To determine the risk factors for pulmonary complications after minimally invasive surgery in elderly patients with vertebral compression fractures (VCFs). Methods: A total of 233 elderly patients (age ≥ 65 years) with VCFs, who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) surgery at Hebei General Hospital from January 2011 to December 2016, were retrospectively analyzed. Risk factors and the effects of the model were determined by univariate logistic regression analyses and the receiver operating characteristic (ROC) curve, respectively. A risk assessment scale was established based on the risk factors, as well as physiological and surgical scores for mortality and morbidity. The risk assessment scale prospectively evaluated risk factors of pulmonary complications after minimally invasive surgery for elderly patients with VCFs from January to June 2017. Results: 27 patients were diagnosed with pulmonary complications (27/233, 11.59%). There were statistically significant differences between patients with and without pulmonary complications in terms of age, body mass index (BMI), smoking, cardiovascular diseases and old fractures between patients with and without pulmonary complications (P < 0.05). Logistic regression analysis showed that smoking, cardiovascular diseases and old fractures were risk factors (P < 0.05) and area under the curve was 0.738 (95% confidence intervals (CI): 0.648-0.828). 53 elderly patients with VCFs were assessed, 5 of them occurred pulmonary complications. Areas under the curve of preoperative and total risk assessment values were all 0.925. Conclusion: Significant risk factors of pulmonary complications were BMI, cardiovascular diseases and old fractures for patients aged 65 years or elderly with VCFs after minimally invasive surgery. The risk assessment scale gained high accuracy.

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Risk factors for cardiac complications after spine surgery

Cited by 27 publications

References 14 publications

Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

A Novel Prognostic Marker in Patients Undergoing Spinal Surgery: Prognostic Nutritional Index

<p>Risk Factors of Pulmonary Complications After Minimally Invasive Surgery for Elderly Patients with Vertebral Compression Fractures</p>

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